Rheumatoid Vasculitis

• Rheumatoid arthritis (RA) is associated with vasculitis in approximately 1% of patients, with a reported decline in the incidence of vasculitis over the last few decades. • Rheumatoid vasculitis (RV) refers specifically to a destructive inflammatory process with protean clinical features that centers on the blood vessel wall. RV can affect a wide range of blood vessel types, from medium-sized muscular arteries to smaller arterioles even post-capillary venules. Thus, its manifestations can overlap with those of many forms of small-vessel vasculitis. • Rheumatoid vasculitis usually occurs in patients with severe, long-standing, nodular, and destructive RA. • RV is more common in males, current smokers, and usually occurs in patients with severe, long-standing, nodular, and destructive RA. • The disease strongly resembles polyarteritis nodosa in its predilection for particular organs: the skin, peripheral nerves, eyes, gastrointestinal tract, and heart. Palpable purpura, cutaneous ulcers (particularly in the malleolar region), digital infarctions, and peripheral sensory and/or motor neuropathy are the most common manifestations. • Tissue biopsy establishes the diagnosis of rheumatoid vasculitis. Deep skin biopsies from the border of ulcers may capture medium-sized vessels that are involved. Nerve conduction studies help identify involved nerves for biopsy. Muscle biopsies should be performed simultaneously with nerve biopsies to increase the diagnostic yield of the procedure. • Despite the widespread use of cyclophosphamide and biologics, the clinical presentation, severity and 5-year mortality (26–60%) have not remarkably changed since the 1980s. • Hydroxychloroquine and aspirin use may reduce risk of developing RV, but warrant further study to support their protective benefit.